Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Noncryopexy versus cryopexy treatment during scleral buckling: a systematic review and meta-analysis

Eye volume 39, pages 1292–1300 (2025)Cite this article

Subjects

Abstract

Objectives

To evaluate the differences in surgical outcomes between scleral buckling (SB) with noncryopexy and cryopexy methods.

Methods

We systematically searched the Embase, Medline, Cochrane Library, and Scopus databases for randomized controlled trials (RCTs) published from their inception until January 1, 2024. A random-effects model was applied, and outcomes are presented as risk ratios (RRs) or standardized mean differences with 95% confidence intervals (CIs). The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation criteria.

Results

We included seven RCTs involving a total of 1103 patients. The meta-analysis revealed comparable retinal reattachment rates between noncryopexy and cryopexy methods (RR: 1.00; 95% CI: 0.96–1.05). Our subgroup analysis revealed similar results between nonretinopexy and laser retinopexy subgroups. Moreover, postoperative visual acuity (VA) and complication rates were comparable between noncryopexy and cryopexy methods (proportion of eyes with postoperative VA of 20/40 or better: RR: 1.24, 95% CI: 0.83–1.85; macular pucker: RR: 1.08, 95% CI: 0.53–2.21; cystoid macular oedema: RR: 1.01, 95% CI: 0.79–1.30; and subretinal pigmentary migration: RR: 0.34, 95% CI: 0.08–1.38). However, the certainty of evidence for these outcomes was low to very low, indicating the need for cautious interpretation of these findings.

Conclusions

Similar surgical outcomes were noted between noncryopexy and cryopexy methods in SB, suggesting that both methods are effective in repairing rhegmatogenous retinal detachment. However, future studies on a larger scale and with longer follow-ups may be necessary to detect late redetachment and complications.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Forest plot of (A) retinal reattachment rate and (B) sensitivity analysis.
Fig. 2: Forest plot of postoperative visual acuity.
Fig. 3: Forest plot of postoperative complications.

Similar content being viewed by others

Data availability

The original contributions presented in this study are included in the article and its Supplementary Materials. Any additional inquiries or requests for data can be directed to the corresponding author.

References

  1. Sultan ZN, Agorogiannis EI, Iannetta D, Steel D, Sandinha T. Rhegmatogenous retinal detachment: a review of current practice in diagnosis and management. BMJ Open Ophthalmol. 2020;5:e000474.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ghazi NG, Green WR. Pathology and pathogenesis of retinal detachment. Eye (Lond). 2002;16:411–21.

    Article  CAS  PubMed  Google Scholar 

  3. Ge JY, Teo ZL, Chee ML, Tham YC, Rim TH, Cheng CY, et al. International incidence and temporal trends for rhegmatogenous retinal detachment: A systematic review and meta-analysis. Surv Ophthalmol. 2024;69:330–6.

  4. Ryan EH, Ryan CM, Forbes NJ, Yonekawa Y, Wagley S, Mittra RA, et al. Primary Retinal Detachment Outcomes Study Report Number 2: Phakic Retinal Detachment Outcomes. Ophthalmology. 2020;127:1077–85.

    Article  PubMed  Google Scholar 

  5. Fallico M, Alosi P, Reibaldi M, Longo A, Bonfiglio V, Avitabile T, et al. Scleral Buckling: A Review of Clinical Aspects and Current Concepts. J Clin Med. 2022;11:314.

  6. Figueroa MS, Corte MD, Sbordone S, Romano A, Alvarez MT, Villalba SJ, et al. Scleral buckling technique without retinopexy for treatment of rhegmatogeneous: a pilot study. Retin (Phila, Pa). 2002;22:288–93.

    Article  Google Scholar 

  7. Mahdizadeh M, Masoumpour M, Ashraf H. Anatomical retinal reattachment after scleral buckling with and without retinopexy: a pilot study. Acta ophthalmologica. 2008;86:297–301.

    Article  PubMed  Google Scholar 

  8. Jaccoma EH, Conway BP, Campochiaro PA. Cryotherapy causes extensive breakdown of the blood-retinal barrier. A comparison with argon laser photocoagulation. Arch Ophthalmol. 1985;103:1728–30.

    Article  CAS  PubMed  Google Scholar 

  9. Campochiaro PA, Kaden IH, Vidaurri-Leal J, Glaser BM. Cryotherapy enhances intravitreal dispersion of viable retinal pigment epithelial cells. Arch Ophthalmol. 1985;103:434–6.

    Article  CAS  PubMed  Google Scholar 

  10. Singh AK, Michels RG, Glaser BM. Scleral indentation following cryotherapy and repeat cryotherapy enhance release of viable retinal pigment epithelial cells. Retina. 1986;6:176–8.

    Article  CAS  PubMed  Google Scholar 

  11. Cowley M, Conway BP, Campochiaro PA, Kaiser D, Gaskin H. Clinical risk factors for proliferative vitreoretinopathy. Arch Ophthalmol. 1989;107:1147–51.

    Article  CAS  PubMed  Google Scholar 

  12. Bonnet M, Guenoun S. Surgical risk factors for severe postoperative proliferative vitreoretinopathy (PVR) in retinal detachment with grade B PVR. Graefes Arch Clin Exp Ophthalmol. 1995;233:789–91.

    Article  CAS  PubMed  Google Scholar 

  13. Dunker S, Faulborn J, Haller EM, Reich ME. The effect of retinal cryoapplication on the vitreous. Retina. 1997;17:338–43.

    Article  CAS  PubMed  Google Scholar 

  14. Uemura A, Ideta H, Nagasaki H, Morita H, Ito K. Macular pucker after retinal detachment surgery. Ophthalmic Surg. 1992;23:116–9.

    CAS  PubMed  Google Scholar 

  15. Avitabile T, Bartolotta G, Torrisi B, Reibaldi A. A randomized prospective study of rhegmatogenous retinal detachment cases treated with cryopexy versus frequency-doubled Nd:YAG laser-retinopexy during episcleral surgery. Retin (Phila, Pa). 2004;24:878–82.

    Article  Google Scholar 

  16. Lira RPC, Takasaka I, Arieta CEL, Nascimento MA, Caldato R, Panetta H. Cryotherapy vs laser photocoagulation in scleral buckle surgery: A randomized clinical trial. Arch Ophthalmol (Chic, Ill: 1960). 2010;128:1519–22.

    Article  Google Scholar 

  17. Mafi M, Mirghorbani M, Ghahvehchian H, Mohammadi SS, Riazi-Esfahani H, Khalili Pour E, et al. Modified Encircling Scleral Buckle Technique Without Subretinal Fluid Drainage or Retinopexy. Ophthalmol Ther. 2020;9:641–51.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Steel DH, West J, Campbell WG. A randomized controlled study of the use of transscleral diode laser and cryotherapy in the management of rhegmatogenous retinal detachment. Retin (Phila, Pa). 2000;20:346–57.

    Article  CAS  Google Scholar 

  19. Veckeneer M, Van Overdam K, Bouwens D, Feron E, Mertens D, Peperkamp E, et al. Randomized clinical trial of cryotherapy versus laser photocoagulation for retinopexy in conventional retinal detachment surgery. Am J Ophthalmol. 2001;132:343–7.

    Article  CAS  PubMed  Google Scholar 

  20. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.

    Article  PubMed  Google Scholar 

  22. Cheng J, Pullenayegum E, Marshall JK, Iorio A, Thabane L. Impact of including or excluding both-armed zero-event studies on using standard meta-analysis methods for rare event outcome: a simulation study. BMJ Open. 2016;6:e010983.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Catalá-López F, Tobías A. Meta-analysis of randomized trials, heterogeneity and prediction intervals. Med Clin (Barc). 2014;142:270–4.

    Article  PubMed  Google Scholar 

  24. Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L. Comparison of two methods to detect publication bias in meta-analysis. Jama. 2006;295:676–80.

    Article  CAS  PubMed  Google Scholar 

  25. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–6.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Axer-Siegel R, Yassur Y, Ben-Sira I. Surgical management of retinal detachment without cryopexy. Am J Ophthalmol. 1981;91:474–9.

    Article  CAS  PubMed  Google Scholar 

  27. Gao XX, Kang CY, Wang RF. Laser photocoagulation versus cryopexy in the treatment of rhegmatogenous retinal detachment. Int J Ophthalmol. 2010;10:1552–3.

    Google Scholar 

  28. Campochiaro PA, Jerdan JA, Glaser BM. Serum contains chemoattractants for human retinal pigment epithelial cells. Arch Ophthalmol. 1984;102:1830–3.

    Article  CAS  PubMed  Google Scholar 

  29. Campochiaro PA, Glaser BM. Platelet-derived growth factor is chemotactic for human retinal pigment epithelial cells. Arch Ophthalmol. 1985;103:576–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This manuscript was edited by Wallace Academic Editing.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Kuan-Ying Chen

  2. Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Yu-Chen Su & Sheng-Min Hsu

Authors
  1. Kuan-Ying Chen
    View author publications

    Search author on:PubMed Google Scholar

  2. Yu-Chen Su
    View author publications

    Search author on:PubMed Google Scholar

  3. Sheng-Min Hsu
    View author publications

    Search author on:PubMed Google Scholar

Contributions

SMH was responsible for conceptualizing the study, supervising the research activities, and overseeing project administration. KYC and YCS contributed to the development of the methodology, carried out the investigation, and performed the statistical analyses. KYC drafted the initial version of the manuscript. All authors reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Sheng-Min Hsu.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, KY., Su, YC. & Hsu, SM. Noncryopexy versus cryopexy treatment during scleral buckling: a systematic review and meta-analysis. Eye 39, 1292–1300 (2025). https://doi.org/10.1038/s41433-025-03614-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41433-025-03614-7

This article is cited by

Search

Advanced search

Quick links